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What is to be done about the UK midwife shortage?

Nick Bosanquet took part in a lively debate this week at the Women’s Institute AGM at the Royal Albert Hall. Over 5000 WI members attended in order to decide the organisation’s campaigning focus for the next year, and vote on the following resolution:

There are chronic shortages of midwives. The NFWI calls on the Government to increase investment in the training, employment and retention of midwives in England and Wales to ensure services are adequately resourced and are able to deliver a high standard of care.

RCM President Professor Lesley Page argued for the motion stating that 
“Whilst the number of midwives has been rising, the number of babies being born has been rising faster – and will continue to rise faster. We need to keep up the pace of recruitment of midwives. We need to increase the number of student midwives.”
Nick provided the opposition; below are his thoughts on the limitations of the proposal.

In an ideal world the proposals of the motion would be highly worthy: but we need to consider whether it is likely to be practicable to remedy shortages through increasing numbers of staff and investment in initial training . We need to look for steps that will help improve the quality of care in here and now.

Investment in training to raise quality is a long term process. Rush training programmes tend to led to reductions in the quality of training and to higher drop out rates. It takes time to train teaching and mentoring staff so that they can give positive support to students who are facing new challenges from the much higher proportion of high risk births. Realistically new midwives are needed to replace many midwives who are retiring over the next 10 years: and overall looms the reality of funding constraints.

There are many positives about the maternity services . In many areas midwives are giving a high standard of care. There are successes in screening programmes carried out by midwives. The proportion of infants who have been born HIV positive has fallen from 10% in 2000 to 2% now as a result of screening programmes. However  there is still variability in the quality of care. Such variability particularly affects the London area  where there the greatest risks– challenges from mothers who have had little contact with ante-natal services  and where it is most difficult to achieve staff stability. There are also high costs from litigation over disability.
What are the key (lower cost) steps which would help midwives in the short term?

1. More support for  units which have the greatest care problems through greater support to unit managers. We could arrange  networks between units which are achieving good results and others and increase incentives to work in these units.
2. Improving the information base both on staffing and on service quality so that we can identify services which need most help.
3. Increase support and in service training to midwives so that they can feel more confident o their skills  in this very demanding care situation.
4. Implement the very sensible proposals by the DoH that each mother should have a named midwife to increase continuity of care.
5. Increase communication with key voluntary organizations  such as Netmums , Mumsnet   and 4Children again as  recommended  recently by the Secretary of State.
6. Lastly the WI can play an important role in adopting local units and showing appreciation and support. Sometimes the positives are  swamped by negatives and the sense of risk. The more that midwives can gain a sense of support from the local community, the more there are will be security about quality of care.

Nick Bosanquet, Volterra Health

1 Comment
  1. I just happened to be lisitneng to OPB on Friday evening and heard your talk. It was the most intelligent, proactive, and inspirational discussion I have heard related to health care and aging. As someone with parents who are now reaching a point where they may not be able to continue to live at home, I am frustrated and angry with the lack of options and focus on prevention and coordination that might assist people as they age, and that address the global reality that we have many more people living longer lives and we need to adapt our medical, social, and economic systems to help them thrive, not just exist. I feel helpless in this system; if there is some way for those of us who are not experts in the field of health care and aging to effect change, please let me know.I look forward to learning more about your work. Thank you!

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